In September 2023 Gavi announced the publication of its 2022 Annual Progress Report, which presents insights into a “year of recovery” for immunisation services thanks to “historic levels of investment” by lower-income countries. Just a few months ago the organisation celebrated the immunisation of over 1 billion children, a milestone that is highlighted in the report. Here we investigate the key themes and concerns of the report. 

The Chair and CEO weigh in 

Professor José Manuel Barroso, Chair of the Gavi Board, and CEO David Marlow open the publication by reflecting on the findings of the report and the goals it presents. They recognise that “nearly half of lower-income countries have recovered to or are above pre-pandemic DTP3 coverage levels”. This is a standard that refers to immunisations with the third dose of diphtheria, pertussis, and tetanus-containing vaccines. However, “some countries saw slower progress”.  

Although the number of so-called “zero-dose children” has fallen from 12.4 million to 10.2 million, this is higher than the estimated 9 million of 2019, with a reduction of 34% required to meet the target for 2025.  

“As we reflect on the important progress and urgent challenges that remain, the Vaccine Alliance nonetheless acknowledges the tremendous effort countries have made to get routine immunisation back on track.”  

Professor Barroso and Mr Marlow recognise that 2022 was “indeed complex and challenging for global health”; COVID-19 caused great suffering and undermined routine immunisations. Polio and diphtheria emerged in some countries for the first time in “decades”, Uganda “battled an outbreak of Sudan ebolavirus”, and mpox was declared a PHEIC. Thus, 2023 was “heralded” as a Year of Renewal.  

In December 2022, the Gavi Board approved “Gavi 5.1”, an “evolution” of the 5-year programme strategy with renewed focus on essential and COVID-19 vaccinations, reaching zero-dose children, introducing new vaccines, and strengthening the Alliance’s role in PPPR: pandemic prevention, preparedness, and response.  

“To make up the ground we lost during the pandemic, in December 2022 the Gavi Board approved a more than $600 million investment to protect 86 million girls [with HPV vaccines] by 2025.” 

With “climate change, deforestation, and migration” come increased risks of infectious disease outbreaks. This has been demonstrated in the “tragic turn” of cholera cases increasing globally. As these risks increase, the importance of Gavi’s commitment to vaccine equity is emphasised. An example of how vaccine equity is challenges it the “dearth of vaccine manufacturing in some regions”, such as across Africa. Gavi recognises its responsibility to “build healthier vaccine markets” by working with African countries and Africa CDC, establishing a greater manufacturing capacity in Africa.  

The foreword concludes with a reflection on the “six core values” that guide Gavi’s work: teamwork, respect, openness, accountability, innovation, and country-driven.  

Leaving no one behind 

Gavi’s “vision” is “leaving no one behind with immunisation”, which translates into the mission: “to save lives and protect people’s health by increasing equitable and sustainable use of vaccines”. This mission is supported with four strategic goals (below) with strategy indicators.  


The vaccine goal 

The report confirms that since 2000, Gavi has helped countries reach over 1 billion unique children with routine immunisation. It also highlights a range of other achievements, including the interesting fact that “children in Gavi-supported countries are better protected than children in other countries” due to the “breadth of protection” by vaccines in the Gavi portfolio. The growth of this portfolio is illustrated in the figure below: 


The other goals are explored through graphics and figures throughout the report, and we encourage you to access it here if you are interested! 

Learning from the report 

What can we take from the facts, figures, and findings of the report? Marlow emphasises that the data show that “immunisation really is a global success story in terms of the unprecedented levels of collaboration”.  

“At the same time, we must not lose sight of the challenges ahead, as countries face a very uncertain future as a result of deteriorating economic conditions, an uncertain geopolitical outlook, and the impact of climate change among other factors. The need for continued collaboration and innovation, today, is greater than ever.” 

Professor Barroso comments that the Alliance’s “priority” is to help countries “maintain this trajectory” of restoring immunisation, broadening coverage, and mobilising domestic resources.  

“The prospect for immunisation to deliver transformative societal and economic benefits is greater than ever, but only if we are collectively able to navigate the path ahead.”  

WHO Director-General Dr Tedros Adhanom Ghebreyesus is encouraged by the “global rebound” in immunisation, which he describes as a “tribute” to those who have worked on it. 

“But global and regional averages don’t tell the whole story, and they mask severe and persistent inequities. When countries and regions lag, children pay the price.” 

He is “proud to work with Gavi” to ensure that every child “benefits from the life-saving power of vaccines”. UNICEF Executive Director Catherine Russell agrees that “the job isn’t done yet”, with many countries “yet to recover the ground they lost during the pandemic”.  

“We must double down on our efforts to reach every child. The recovery has started, now let’s make sure it’s equitable and durable.”  

If you’ve read the report, what do think it means for the global vaccine community? How can Gavi-supported countries continue to recover, and what are the implications for countries that don’t receive support from Gavi?  

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